Health

Doxorubicin for unresectable hepatocellular carcinoma: a prospective study on the addition of verapamil

Article Abstract:

There have been reports that verapamil, a calcium-channel blocker, may increase the cytotoxic effect of doxorubicin on cancer cells. Furthermore, the combined effect may be especially potent on cancer cells that are resistant to chemotherapy. Verapamil may also be of value in improving the function of a cirrhotic liver. These indications made verapamil an appealing potential addition to chemotherapy for liver cancer to researchers in Hong Kong, where the majority of patients with hepatocellular carcinoma also have cirrhosis of the liver. A study was devised to evaluate the use of verapamil as an addition to doxorubicin chemotherapy in 28 patients with hepatocellular carcinoma that was not amenable to surgical treatment. In 20 of the 21 patients for whom an adequate tissue specimen was available, cirrhosis was confirmed. The results failed to identify any benefit obtained from the addition of verapamil. Only one patient achieved a complete response and the median survival was 57 days overall. There is also reason to believe that the addition of verapamil actually increased the toxicity of the treatment. Three patients in the study died of infections; in the authors' previous experiences with doxorubicin alone, no patient had developed infection. Furthermore, three patients developed dysfunction of the heart muscle; in one case this was serious enough to cause clinical symptoms. Different treatment protocols or different dosage schedules may yet demonstrate some benefit of adding verapamil to doxorubicin treatment of liver cancer. However, the seriousness of the toxic effects observed in this study suggest that any future verapamil study must carefully monitor patients and the dosage of the drug. (Consumer Summary produced by Reliance Medical Information, Inc.)

Early treatment of acute biliary pancreatitis by endoscopic papillotomy

Article Abstract:

Emergency endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic papillotomy may reduce the incidence of bacterial infections in patients with acute biliary pancreatitis. ERCP is a technique used to examine the pancreas, and endoscopic papillotomy is the surgical dislodging of biliary stones. Of 195 patients with acute pancreatitis, 97 underwent ERCP within 24 hours after hospital admission, and of them, 37 underwent endoscopic papillotomy. The other 98 patients initially underwent conservative treatment and ERCP with or without endoscopic papillotomy if their condition worsened. No patients in the early intervention group developed bacterial infections compared with 12 patients in the conservative treatment group. Furthermore, the death rate was lower among patients undergoing emergency ERCP. Emergency ERCP did not appear to have any harmful effects even on patients who did not have biliary pancreatitis.

Endoscopic biliary drainage for severe acute cholangitis

Article Abstract:

Endoscopic biliary drainage may be safer and more effective than surgery for treatment of patients with severe acute cholangitis caused by a stone in the bile duct. Cholangitis is inflammation of a bile duct, a duct that transports bile between the liver and the intestines. Of 82 patients with severe acute cholangitis, 41 underwent endoscopic biliary drainage, and 41 underwent surgery. Complications occurred in 14 patients (34%) who underwent with biliary drainage, compared with 27 (66%) who underwent surgery. Four patients (10%) in the endoscopy group died, compared with 13 (32%) in the surgery group. The time required for temperature normalization and blood pressure stabilization was approximately the same in both groups, but patients who underwent surgery required mechanical ventilation more often. Patients with cholangitis caused by a bile duct stone who undergo emergency surgery often have complications or die.